Important piece by NPR's Richard Knox, "Offshore Stem Cell Clinics Sell Hope, Not Science." Read by following the link, or listen:

Kaiser Health News proves its value once again with an under-the-radar story covering some items you won't see in many other news sources.

Excerpt:

"...several lesser-known provisions also take effect in coming months that could have a lasting impact on the nation's health care system.

These provisions include eliminating patients' co-payments for certain preventive services such as mammograms, giving the government more power to review health insurers' premium increases and allowing states to expand Medicaid coverage to low-income adults without children.

While these changes might not have gotten at lot of attention, they could help build support for the law in the run-up to the contentious mid-term elections."

Their list:

• Prevention For Less
• Knowing Which Treatments Work Best
• Helping Cover Early Retirees' Health Costs
• Keeping Tabs on Health Insurance Premiums
• Expanded Medicaid Coverage
• Care Coordination for 'Dual Eligibles'
• FDA Approval For 'Follow-On Biologics'

Read the full story at the link above for details.

Former US Senator David Durenberger (R-MN), in his monthly commentary from the National Institute of Health Policy at the University of St. Thomas, writes about an example of a patient and a provider balking at evidence and outcomes data.

The commentary is built on the back of a story in the St. Paul Pioneer Press by Jeremy Olson (who is leaving soon to join the Star Tribune across the metro). Durenberger writes:

For many years MN health insurance companies like BCBSMN have been trying to convince members that they can provide more value for the premium prices they charge, because they can give members access to higher value health care services. This is what the HMO has been about for three decades and "data on docs" and the creation and sponsorship of the Institute for Clinical Systems Improvement (ICSI). For example, Health Partners Medical Group reports key clinical outcomes of more than 400,000 patients classified, since 2004, by socio-economic status, race and ethnic group because more than 90% of their patients will trust them with that kind of information.

Jeremy Olson, St Paul Pioneer Press, writes about an interesting new chapter in this effort. A 38-year-old leukemia patient is concerned that BCBSMN requires her to go to the Mayo Clinic for a bone marrow transplant rather than to the University of Minnesota where she has received all her care. "It breaks my heart," the patient says. But BCBSMN has the local and national data to show that Mayo's transplant outcomes for cases like hers are better than the UMN. The response from UMN is: "We treat the toughest cases that others won't." This is the kind of response we've become used to hearing when outcomes research is used to inform and to direct pre-paid patient decisions.

It doesn't hold water. When lives are at stake, and reputations are on the line, research data must be as precise as possible. There are those in the medical industry who love bashing insurers and managed care even more than President Obama does. Traditional insurance plans will tell you that hospitals with less than the best outcomes may be motivated by their finances in taking on cases for which success is less likely. I will always recall the two neurosurgeons involved in the development of the cyber-knife telling me about a Miami colleague who bought two and was making a mint off "hopeless" tumor cases.

When the UMN says their cancer transplant cases are "tougher" than Mayo's and therefore their success rate is lower, they need to be asked first to prove it, and then whether admission decisions can be affected by reimbursement which is unrelated to outcomes. What I would love to know, were I this patient, is which cancer centers, or which oncological surgeons, in this country have even better results for people like me than Mayo. Maybe one is right here in Minneapolis?

This gap - between what evidence shows on outcomes - and individual or institutional resistance to the evidence - is a huge barrier standing in the way of any meaningful health care reform.

Kudos to Jeremy Olson and David Durenberger for writing about it.

The Project for Excellence in Journalism has published an analysis of news covergae of the health care reform debate from June 2009 through March 2010. If you care about such stuff as much as we do, you should read the full report. But here's a key excerpt from their conclusion:

"No one lavished more attention on the subject than the talk show hosts, who spend much of their time engaging in ideological warfare. And the terms that resonated in the media narrative, perhaps most notably "death panels," were those that packed a polarizing punch.

All of which raises the question of the extent to which the media shed light versus heat when it came to health care reform. Certainly, many outlets did good work covering the numerous layers of the complex issue. But it's also true that the public seemed consistently confused by the health care debate and had a difficult time sorting out fact from fiction.

That was by no means entirely attributable to the media. But to the extent that the health care experience may shape the rest of the Obama presidency, it may also offer lessons for the journalists who cover it as they navigate in a changing media world."

Care to nominate your favorite (least fave?) polarizer on this topic? Do so in the comments area.

Reuters reports on a study in the current Archives of Internal Medicine that shows that:

"...after the U.S. Congress had mandated Medicare coverage of a digital tool to help detect breast cancer, health providers were quick to pick it up even though it hadn't showed clear-cut benefits for the women.

The technology, known as computer-aided detection, costs more than $100,000 to install, according to the researchers...

"It illustrates a bigger problem that exists in our society, where the rails are really greased to get new technologies into practice before we are sure that they are safe," Dr. Joshua J. Fenton, who led the study, told Reuters Health.

"There is no evidence that the use of computer-aided detection reduces breast cancer mortality," he added.

A commentary by Dr. Karla Kerlikowski in the same journal calls for "evidence of benefits outweighing harms before implementing new technologies." Excerpt:

Why do new technologies get disseminated so quickly when evidence is incomplete and/or conflicting? One explanation is that the focus of evaluating new diagnostic tests is on providing evidence to support improved or at least equal benefit of the technology with much less attention to the potential harms of new technologies prior to dissemination. In other words, the benefit of the new technology compared with existing technologies is examined but not necessarily whether the potential benefit of the new technology outweighs the harms of the test. In addition, the designs of comparative studies are often maximized to measure the added benefit of the test to detect disease compared with standard tests rather than assessing effectiveness in community practice on important clinical outcomes. Lastly, there are several forces that may encourage the rapid adoption of new technologies, including investigators with professional interests, technology companies with financial investments, lobbyists with vested interests, and a public convinced that new advanced technology is always better.
...
Health care providers and individuals cannot presume that newer technologies are better than existing ones without actual data to that effect. Health care providers should not adopt new technologies without first demanding scientific evidence beyond that required for FDA approval. They need to ask how strong and consistent is the evidence for new technologies and whether the evidence shows an important clinical benefit, whether there are important harms, and whether the benefits outweigh the harms. To be responsible advocates for high-quality medical care, our enthusiasm for new technologies should not replace strong, consistent evidence that the benefits of the new technology outweigh the harms in a clinically important way.

Finally, in another commentary in the journal, this one by Dr. George Sawaya on the attempt to reduce harms of cervical cancer screening "by setting appropriate lower and upper age limits for screening and avoiding too-frequent testing among average- and low-risk individuals," harms are another key focus:

To move forward, clinicians and patients must first be more cognizant of screening harms in all its forms, and studies must be designed to measure not only the likelihood of benefit with various screening strategies but also the likelihood of harm. Second, comprehensive and integrative methods must be identified and used to determine an appropriate balance between benefits and harms that seems reasonable to a variety of stakeholders. Finally, the rationale behind screening guidelines designed to maximize benefits and minimize harms must be clearly communicated to everyone.

While the "less is more" argument may never be convincing to many stakeholders in cancer screening, its rationale should resonate with many clinicians steeped in the tradition of doing no harm.

The Associated Press, which sometimes may be viewed as only reacting to breaking news of the day, today published a timely and timeless feature explaining:

"Anywhere from one-fifth to nearly one-third of the tests and treatments we get are estimated to be unnecessary, and avoidable care is costly in more ways than the bill: It may lead to dangerous side effects."

It's timely because, on the heels of the New York Times' criticism of Dartmouth Atlas methodology, it refers to Atlas data that shows that:

".. in parts of the country, Medicare pays double or triple the price to treat people with the same illnesses. The differences are not fully explained by big cities' higher cost of living or populations that are poorer, older or sicker. How much care someone gets is a main reason, yet Dartmouth's data shows people in pricier areas don't necessarily fare better."

It's also timely because, on the heels of a study published in Health Affairs that showed that many people surveyed thought more care meant higher-quality, better care, this story led with:

"More medical care won't necessarily make you healthier -- it may make you sicker. It's an idea that technology-loving Americans find hard to believe."

Nice team effort by AP with contributions from Lauran Neergaard, Ricardo Alonso-Zaldivar, Lindsey Tanner and Marilynn Marchione.

(Disclosure: the story quotes Dr. Michael Barry, president of the Foundation for Informed Medical Decision Making, which supports my HealthNewsReview.org project.)

Yale's Harlan Krumholz blogs on the Forbes site today, making a strong case for shared decision-making even though he doesn't use that term in his post. Excerpt:

"A few weeks ago I made a modest proposal to the medical profession in the pages of the Journal of the American Medical Association. I suggested that we make informed consent meaningful and provide patients with the critical information that should be available to anyone contemplating a major test or procedure.

I suggested that in non-urgent situations, when there is time for deliberation, patients be told their options, given realistic estimates of risks and benefits, informed about the track record of the institution and physicians who will provide the service, and provided an estimate of the costs to them.

My proposal was to standardize the information to patients who are considering some of the most common elective tests and procedures. Assemble panels of expert doctors and determine where there is consensus about the minimum information that all patients should know. Work with educators and psychologists to determine how to convey the information fairly and impartially. Inform patients that the best decision will be aligned with their values and preferences and that no one decision is right for everyone.

This solution to rising health care costs does not involve rationing care. It does not shift payments to patients or reduce payments to doctors. It does not require complicated legislation or regulation. The solution simply ensures that patients are making an informed decision."

The worst-kept secret in journalism circles recently was that the New York Times was planning an article critical of the Dartmouth Atlas. That article was published online last night.

Among the main points in the article:

• "The mistaken belief that the Dartmouth research proves that cheaper care is better care is widespread."

• "the atlas's hospital rankings do not take into account care that prolongs or improves lives."

• "Even Dartmouth's claims about which hospitals and regions are cheapest may be suspect."

• "failing to make basic data adjustments undermines the geographic variations the atlas purports to show."

The Times has also published the correspondence it had with the Dartmouth team about methodology questions.

The Dartmouth team challenges each of these criticisms in a pdf statement online. The team says the Times made at least five factual errors and several misrepresentations. They write: "What is truly unfortunate is that the Times missed an opportunity to help educate the American public about what our research actually shows -- or about the breadth of agreement about what our findings mean for health care reform."

Oddly, the Times called the Atlas researchers "a once obscure research group at Dartmouth College." I guess if you consider "once obscure" as 20 years ago you might be right. Putting that phrase in the opening sentence opened the discussion on a questionable note.

The Times is correct in stating that "The debate about the Dartmouth work is important."

But as Merrill Goozner wrote on his blog today,

"...as is often the case in journalism, the attempt to reduce complex realities into a single-factor analysis that can be summarized in a headline or a single "why this story is important" paragraph can leave a mistaken impression. Regional variation in Medicare spending is one indicator of gross overutilization. Something is happening when a hospital in McAllen, Texas does twice as many knee implants per Medicare beneficiary as a hospital in Rochester, Minnesota.

But that by itself tells us nothing about why that overutilization occurs. Greedy doctors or hospitals working in a fee-for-service system are part of the problem. Cost shifting due to high levels of uninsurance and illness severity also may account for some or even much of those differences. And, as the Times report points out, quality differentials have to be taken into account.

The pushback by Dartmouth defenders has already begun. Columbia University professor Andrew Gelman on his blog suggests the reporters need a lesson in statistics. My complaint with today's story comes from an entirely different angle. Higher quality care lowers costs, it doesn't raise costs."

Thoughtful people should read a lot about the criticism and the countering comments from Dartmouth. This is not something that can be absorbed in a headline, in a nut graf, or in a quickie talk show segment.

Disclosure: I worked at Dartmouth throughout the 90s, right down the hall from many of these Atlas researchers. I consider many of them my friends. My work is currently supported by the Foundation for Informed Medical Decision Making, one of whose co-founders was Dr. Jack Wennberg of Dartmouth, whose work was the basis for the Atlas project.

The big ALLHAT study of drug treatments for high blood pressure showed, as Harvard's Jerry Avorn writes, "that for patients with hypertension but no major comorbidities, thiazide-type diuretics were as good as or better than other agents that at the time were considerably more costly, many hoped this "old-fashioned" approach would gain new respect and credibility. Yet, publication of this landmark study resulted in a surprisingly small change in patterns of care."

Today Avorn has an invited commentary in the Archives of Internal Medicine in reaction to a study that MedPageToday.com describes in this way:

"Face-to-face educational presentations by investigator-educators, a practice known as academic detailing, was associated with a small but significant increase in the use of thiazide diuretics for hypertension."

In his commentary, Avorn writes:

"Many well-documented advances in therapy are not adopted widely or quickly, whereas other, unimpressive new treatments are taken up in epidemic proportions, their use often fueled by marketing campaigns that are far more powerful than the medicines being advertised. As a result, patients are frequently exposed to new therapies that may be less effective or less safe than the older regimens they replace. For example, ezetimibe (Zetia and Vytorin; Merck/Shering-Plough Pharmaceuticals, North Wales, Pennsylvania) may not prevent atherosclerosis as well as the statin-only regimens it displaces for many patients; rosiglitazone maleate (Avandia; GlaxoSmithKline, Philadelphia, Pennsylvania) increases the risk of cardiovascular disease in patients with diabetes mellitus; and rofecoxib (Vioxx; Merck & Co Inc, Whitehouse Station, New Jersey) nearly doubled the occurrence of myocardial infarction or stroke in patients who took it, while offering no greater analgesic efficacy than older nonsteroidal anti-inflammatory drugs, such as naproxen sodium. The lavish promotion that drives such overuse is reserved for the most expensive drugs, because only a high-priced product can provide its manufacturer with the economic benefit to justify a big marketing campaign. Patients are left to bear the burden of the mediocre efficacy or increased risk of these products, while all of us get to pay for their high cost."

He says the study published today wasn't about "real academic detailing" but rather "far less effective group presentations, many of which probably degenerated (in a behavior-change sense) to conventional talk-at-you lectures. It is therefore not surprising that its impact on changing practice was so modest."

A story done in partnership between Kaiser Health News and the Washington Post reports:

"Provo's spending increases aren't an aberration. Annual average spending grew at 7 percent or more in other traditionally low-cost areas, including Oxford, Miss.; Wausau, Wis., and Durham, N.C. Even in Rochester, Minn., home of the highly regarded Mayo Clinic, and Salt Lake City, where Intermountain is headquartered, Medicare costs grew faster than the national average."

Other quick excerpts:

Harvard professor Michael Chernew noted in a recent article that "even the most efficient delivery systems must wrestle with the adoption of expensive new technologies."

"The gastroenterologists owning their own CT scanners, the oncologists owning their own radiation machines," says Dr. Wendell Gibby, a radiologist who owns his own imaging clinic. "If you've got a million dollar scanner, you end up using it," he says.

Read the whole piece. Good journalism.

Regardless the shape and impact of health care reform legislation, how new health care technologies are communicated to the American public is a major issue. And today a reader sent me a new example of how journalism must improve.

The Asbury Park (NJ) Press reports on a local medical center trumpeting its use of two technologies to treat lung cancer - Cyberknife and Super D. The story reads like a hospital news release, using phrases such as:

• "puts hospital on the cutting edge"

• "The intrusive ways of the past to diagnose and treat cancer -- by using the needle and scalpel -- are being replaced by the electronic hum of computers and the whir of robots."

• "Riverview is the only medical center in the state with Super D and the latest Cyberknife technology"

• "We have the newest technology in the state"

• "It also means treatment can begin sooner and have a better outcome"

Well, wait just a minute about outcomes. The story contains no data, no evidence, no proof of better outcomes.

In fact, hidden away at the very end of the story is this:

"Academic studies are now underway comparing the effectiveness of Cyberknife cancer treatment to conventional surgery."

Usually, we want to wait until the studies are done and until the evidence is in before we proclaim that something is "curing the cancer" or that it's "the wave of the future." Otherwise that wave can become a tsunami of overuse and runaway costs - before we even know if what's newer is better.

The AP reports that a group opposing the current health care reform legislation has "outraged" Pennsylvania Democratic Rep. Kathy Dahlkemper, who recently lost both parents to cancer.

The ad reflects on the US Preventive Services Task Force's breast cancer screening recommendations from last November. Among the distortions in the ad are its claims that the "government panel that didn't include cancer specialists says women shouldn't get mammograms until age 50. ... If government takes over health care, recommendations like these could become the law for all kind of diseases."

That isn't what the task force said. And the big government takeover theme is classic rhetorical fear-mongering.

More from the AP:

"Dahlkemper called for the ad to be pulled. But its sponsor, Americans for Prosperity, has refused.
...
"In the past month, I've lost both my parents to cancer," she said in a statement. "It's truly disgraceful for outside groups to then attack me for not being tough enough on cancer."
...
The nonpartisan group Factcheck.org denounced the ad for its "sheer number of falsehoods." Politifact, another independent group, gave the ad its lowest rating for truthfulness and accuracy: "Pants on Fire."

AP reports that Dahlkemper was targeted in an ad campaign that is being echoed throughout 18 Democratic districts.

That's the title of an op-ed piece by Dr. Gilbert Welch of the Dartmouth Institute of Health Policy & Clinical Practice. Excerpts:

"Here's a question that's not being asked in the healthcare debate: How much medical care do we want in our lives? It's something we should be discussing.

Start with the two life events we all experience, birth and death.

My profession has gotten pretty good at terrifying (and operating on) pregnant women during what should be one of the greatest experiences in life. And we are equally proficient at dragging the elderly through all sorts of misery on the road to death.
...
So the most fundamental life events -- birth and death -- increasingly involve more and more medical care. Why should you care about this increasing medicalization of birth and death?

Simple. Because it exemplifies the medicalization of life. Everyday experiences get turned into diseases, the definitions of what (and who) is normal get narrowed, and our ability to affect the course of normal aging get exaggerated. And we doctors feel increasingly compelled to look hard for things to be wrong in those who feel well.

Medicalization is the process of turning more people into patients. It encourages more of us to be anxious about our health and undermines our confidence in our own bodies. It leads people to have too much treatment -- and some of them are harmed by it.

And it's big part of the reason why medical care costs so much.

There are many areas in which medical care has a great deal to offer. But it has now gone well beyond them. There may have been a time when the words "Do everything possible" were indeed the right approach to medical care. But today, with so many more possibilities for intervention, that's a strategy that is increasingly incompatible with a good life. We all need to be a little more skeptical and -- to really be healthy -- willing to ask "Why?"

Don't just settle for my excerpts. Read the entire article.

Not to be missed in this week's Archives of Internal Medicine is an invited commentary, "The Prostate Cancer Treatment Bazaar," by Dr. Michael Barry. After describing about a dozen different treatment options for prostate cancer, Barry writes:

"Complicating the decision, there is an embarrassing lack of comparative clinical trials among these therapies. In fact, for the majority of men who are 65 years and older when newly diagnosed as having prostate cancer, the only randomized trial suggests that arguably the most aggressive of the treatments, radical prostatectomy, and the least aggressive, watchful waiting, have similar prostate cancer-specific mortality over 12 years of follow-up.
...
Given this knowledge vacuum, the type of a physician a man consults may unduly influence his choice. Since many men with prostate cancer discovered through screening have an excellent outcome for years, even without attempted curative therapy, specialists may then naturally assume, based on personal experience, that their treatment works. But increasingly, there are complex financial motives that may lead to bias as well. Large capital investments in equipment for robotic surgery or proton beam therapy, for example, create an intense need to recoup investments by increasing patient throughput. A recent paradox has been the investment by urology groups in roughly $3 million worth of equipment for intensity-modulated radiotherapy, given very favorable reimbursement for this treatment and despite evidence that its marginal benefit over 3-dimensional conformal therapy is meager relative to its cost.
...
Fully informing men about their prostate cancer treatment options involves honestly telling men what we do not know as well as the little we do. It requires a shared decision-making process, in which patient preferences, not physician specialty and certainly not physician investment, determine the treatment course. It is time to make a real shared decision-making process for prostate cancer and other major health problems a "major appliance" in the patient-centered medical home."

Read the entire commentary.

(Disclosure: Dr. Barry is president of the Foundation for Informed Medical Decision Making, which is the sole supporter of the HealthNewsReview.org project.)

I was struck by the recurring themes in this week's health news and planned to blog about it today. But Lindsey Tanner of AP beat me to it with her story, "Experts say US doctors overtesting, overtreating."

She begins:

"Too much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggest that too many Americans - maybe even President Barack Obama - are being overtreated.

Is it doctors practicing defensive medicine? Or are patients so accustomed to a culture of medical technology that they insist on extensive tests and treatments?

A combination of both is at work, but now new evidence and guidelines are recommending a step back and more thorough doctor-patient conversations about risks and benefits."

I had picked up on that same theme in this week's news:

• An independent panel convened this week by the National Institutes of Health confronted a troubling fact that pregnant women currently have limited access to clinicians and facilities able and willing to offer a trial of labor after previous cesarean delivery.

• A troublingly high number of U.S. patients who are given angiograms to check for heart disease turn out not to have a significant problem, according to the latest study to suggest Americans get an excess of medical tests.

• CT scans may pose cancer risk, new research indicates: Doctors, patients should weigh risks vs. rewards of medical imaging. (Chicago Tribune story.)

• Controversy over "value-based insurance design" that tries to address the problem of underuse of proven treatments and overuse of certain surgeries and diagnostic tests that may be less valuable. (Kaiser Health News story.)

• Expensive prostate cancer treatments are winning out over the old standards, driving up the cost of treatment before there's clear evidence that they improve outcomes. (MedPageToday.com story.)

• Dr. Richard Ablin's op-ed in the New York Times, "The Great Prostate Mistake." Excerpt:

"Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit."

• And the letter to the editor that followed:

To the Editor:

I can only wish that Richard J. Ablin's article had appeared years ago and spared me and probably many others needless pain and anxiety.

In 1997, at the urging of a couple of friends, I walked into a clinic feeling great and a bit foolish. P.S.A., 9-plus. Biopsy, of course (ouch), and I was told of a "little suspicious gray area" on a film. Lab test result, positive. Doctor recommendation: surgery or radiation.
I decided against both and never looked back, and have lived happily and healthfully ever after.

By the way, the 10 or 15 percent chance of bad side effects (I asked) from surgery is really far higher, from what I've read and heard. Watchful waiting is still the best suggestion any doctor can offer.

Robert S. Corya
Indianapolis, March 10, 2010

• CBS' Harry Smith's live colonoscopy coverage that never touched on any questions about evidence for colonoscopy and some of the questions that have been raised about the overselling of colonoscopy - perhaps resulting in the decline in use of a $20 blood stool slide test.

While Smith's colonoscopy was being televised, I was attending a meeting entitled, "First, Do No Harm," hosted by the US Agency for Healthcare Research & Quality. The purpose of the meeting was to guide future AHRQ research on how to get doctors and patients to stop pursuing approaches for which there is net harm - not benefit. Clearly, health care in the US struggles even with the clearcut issues of cutting back in the face of net harm - much less in grey areas where there is uncertainty about harms vs. benefits.

But kudos to Lindsey Tanner of AP for trying to tie together the week's news in the way she did. We could have stories like that every week. And if we did, we'd have a lot smarter health care consumer population.

Julie Appleby of Kaiser Health News has an intriguing story about five insurers in Oregon offering "value-based insurance design."

She explains:

"...a new type of insurance that offers free care for some illnesses, such as diabetes or depression, but requires hefty extra fees for treatments deemed overused, including knee replacements, hysterectomies and heart bypass surgery.
...

The policies are among the first to apply financial incentives on both sides of one important factor driving up the nation's health care tab: The underuse of proven treatments and overuse of certain surgeries and diagnostic tests that may be less valuable."

The Center for Public Integrity has posted a searchable database of what they say are the 1,750 companies and organizations that have hired 4,525 lobbyists to influence health care reform legislation. The Center states:

"Despite the recession, 2009 was a boom year for influence peddling overall with business and advocacy groups shelling out $3.47 billion for lobbyists to represent them on all kinds of issues, according to the nonprofit group Center for Responsive Politics.

Much of that money went to fight the health reform battle, according to Center for Public Integrity data. Businesses and organizations that lobbied on health reform spent more than $1.2 billion on their overall lobby efforts. The exact amount they spent on health reform is difficult to quantify because most health care lobbyists also worked on other issues, and lobby disclosure rules do not require businesses to report how much they paid on each issue.

From an industry perspective, it was money well spent. A close look at the health reform bills that passed the House and Senate show lobbyists were apparently effective at blocking provisions like a robust government-run insurance program, and blunting the effect of cost-cutting measures on health care companies."

WBBM in Chicago last week asked, "Is Medicare Ignoring Cheaper Lung Cancer Test?"

In its report, the TV station's "investigator" team promoted a company president's complaints against Medicare for much of the piece. They let him get away with saying:

"This is a potentially very powerful tool in the toolbox against lung cancer. You can zap the cancer and potentially be cured of early-stage lung cancer without ever having the surgery."

Should we be hearing that from a company president worried about his bottom line while he "wows" the audience with blown-up images like the one at left that appeared in the story? Or should we hear about evidence and data from an independent investigator whose research could speak to efficacy? The story never provided any data to back up the company president's self-interested claims.

They also let him get away with saying, "I think it has the potential to save Medicare millions of dollars."

We're not getting much smarter from stories like this. We're sure not getting a better understanding that in health care, "more is not always better and newer is not always better." We're also not being shown how often special interests - Pharma, device makers, specialty physician groups, etc. - are digging in against health care reform.

Recently, Trudy Lieberman wrote in the Columbia Journalism Review about how cardiologists were using journalists to complain about their reimbursement levels being cut by Medicare. She wrote:

"The doctors' letter warned that they "will be either forced out of business or forced to drastically increase the number of patients seen, most likely with physician assistants or nurse practitioners." Oh, oh. The specter of rationing and inferior care--"

See the similar themes in what she wrote about and in what we saw in the Chicago WBBM story?

Lieberman praised a Miami Herald story for how it handled the issue but said that:

"..a bunch of news articles for the most part passed along the cardiologists' complaints, threats, and warnings without any hint that there was another side to the story. Between the slanted newspaper articles and audio news releases from the American College of Cardiology, millions of Americans learned that the incomes of heart doctors, which can be upwards of $400,000, could take a hit. As an example of the kinds of cuts Medicare envisioned under the new rule, the administrator of one Florida heart practice explained that the reimbursement for a nuclear stress test could drop from $850 to $600. Presumably he said it with a straight face."

News stories that foster rhetoric and fear-mongering aren't making us any smarter. As Lieberman wrote:

"Containing the runaway cost of medical care is the thorniest of all the thorny issues in the health-reform debate. It is a complicated, charged, and crucial issue; the press needs to dig in and own it."

The health spendings projection article in Health Affairs contains this one historic note:

In 2009 the health share of gross domestic product (GDP) is expected to have increased 1.1 percentage points to 17.3 percent--the largest single-year increase since 1960.

A Los Angeles Times story gets to the heart of the matter:

"There is growing concern that as much as a third of the medical care delivered in this country does not help patients.

"Are we getting value for the dollar? That is the question," said Len Nichols, health policy director at the centrist New America Foundation. "If you believe that so much medical care is unnecessary, as I do, then it is criminal that we are spending so much."

Yet there is gridlock on federal health care reform legislation. Indeed, for all the rhetoric and fear-mongering about "government taking over health care," the latest data shows we're already there.

The Wall Street Journal reports and provides this graphic:

"For the first time, government programs next year will account for more than half of all U.S. health-care spending, federal actuaries predict, as the weak economy sends more people into Medicaid and slows growth of private insurance."

One of the reasons we review news stories about "new stuff" in health care is that we believe news stories may drive up undue demand for unproven, perhaps unsafe, and costly new technologies without giving a balanced picture of the tradeoffs between harms and benefits, without evaluating the quality of evidence behind the new ideas, without looking at conflicts of interest in those promoting the new ideas, etc.

At last check, 70% of the nearly 1,000 stories we've reviewed fail to adequately discuss costs, or quantify harms or benefits. A kid-in-the-candy-store view of US health care.

We believe these are health care reform stories - even though they often aren't presented that way. Just look at what we've written about just in the past week and you see the daily drumbeat of news stories and ads that fill our heads with visions of sugar plums in health care.

• CT and MRI scans

• Robotic surgery

• A weeklong network TV series taking you inside the O.R. for technological wonders

• Misleading drug ads

17.3% of the GDP and rising.

A team of reporters from KHN delivers this thoughtful piece. Excerpts:

"There's nothing in (the proposals) the average person could understand about why your costs would be lower," says Robert Blendon, professor of health policy at Harvard's School of Public Health. "They don't even have good illustrations about how it would be cheaper. They did not find a way to save money for people with job-based insurance." ...

Many of the taxes have been dropped or scaled back. Others have been designed to pressure the health care system to operate more efficiently. But the laundry list of levies has fueled concerns that Americans, struggling with the severest economic slump in decades, would have to pony up more for the tax man.

"The final bill will not have all those taxes in it," says Blendon, "but people hear about the tax on insurers, the tax on pharmaceuticals, the income tax - and they can't segregate it in their minds." Opposition to taxes was a key part of (newly-elected Massachusetts Senator Scott ) Brown's campaign.

"People don't like taxes," says Leslie Norwalk, who was acting director of the Centers for Medicare and Medicaid during the administration of President George W. Bush. "The electorate is trying to decide what it thinks about this health care stuff, sees the economy is in trouble and a lot of discussion about taxes, but isn't all that unhappy about their own healthcare. Weighing those two things can be difficult."

"Ranking 37th -- Measuring the Performance of the U.S. Health Care System" is an article posted online by the New England Journal of Medicine. Excerpt:

Despite the claim by many in the U.S. health policy community that international comparison is not useful because of the uniqueness of the United States, the rankings have figured prominently in many arenas. It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy. These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?

What an important question for US journalists to tackle more deeply more often.

Jim Ragsdale of the St. Paul Pioneer Press wrote a terrific column this week, "Rational health care, not rationed." It begins:

"I invented a device called Jim's Full Body Scanner. It takes up a city block, which means it cost kabillions to build and operate. But for $50,000 per scan, the Jimmer, as I call it, can give you a cell-by-cell breakdown of your bod. It can show dozens of microscopic changes, giving you a chance to take pre-emptive medical action.

Most of those scanned go right to a conveniently located miniJim Clinic for further tests, a biopsy or two, some minor surgeries or maybe even a pre-emptive transplant. I admit that it's controversial. We don't really know if some of the fixes are needed. The eggheads want long-term studies and "evidence" before deciding whether insurers should pay.

"Rationing!" I say. "They've put a bureaucrat between you and the Jimmer!"

OK, I didn't actually invent any such device. I am an aging civilian scribe whose anatomical knowledge is well below average. I imagined the "Jimmer" because it helps me understand the battle over scientific evidence and its relation to the gaping holes into which our health-care dollars disappear."

From Drew Altman, PhD, president of the Kaiser Family Foundation. Read the entire column, but here's an excerpt:

With so much of the media now configured for instant news and the relentless pursuit of controversy, stoked by spin and manufactured news by partisans on both sides, the many great journalists in the news business working hard to inform the public face a big challenge in explaining the complex issues in health reform.

MinnPost.com columnist David Brauer wonders why the Washington Post - and not a local news organization - asked tough questions about whether the Mayo Clinic is a replicable model for health care reform.

His new book, "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," was published this week. But this myth column was published in the Washington Post on Sunday.

Here's the tease of the five myths. Read the full article to see how he backs up each of the five.

1. It's all socialized medicine out there.

2. Overseas, care is rationed through limited choices or long lines.

3. Foreign health-care systems are inefficient, bloated bureaucracies.

4. Cost controls stifle innovation.

5. Health insurance has to be cruel.

"Smoking Memo - or Bad Journalism" - that's the title of Maggie Mahar's blog post on the alleged Obama-PhRMA deal. Excerpt:

Yesterday, it seemed that the Huffington Post's Ryan Grim had a scoop. He reported that Huffington has obtained a memo that "confirms" that the White House and the pharmaceutical lobby secretly made a deal--the deal that I wrote about a few days ago in a post titled "What Was Billy Tauzin Thinking?" According to the memo, the White House supposedly pledged to oppose any Congressional efforts to let Medicare negotiate for discounts on drugs, or to import drugs from Canada.

The memo in question turns out to be typed--and unsigned. How does the reporter know that it is authentic? "A knowledgeable health care lobbyist" told him so. According to the lobbyist the memo "was prepared by a person directly involved in the negotiations [and it] lists exactly what the White House gave up, and what it got in return.

Wait a minute. As PhRMA senior vice president Ken Johnson points out later in the story: "Anyone could have written it. Unless it comes from our board of directors, it's not worth the paper it's written on. . . ."

And who is the "knowledgeable lobbyist" who gave the memo to Huffington? His name is not disclosed.

What we have then, is a story based on what one unnamed source says--and a typed memo that probably is untraceable.

She goes on to quote me about whether this is acceptable journalism.

"Smoking Memo - or Bad Journalism" - that's the title of Maggie Mahar's blog post on the alleged Obama-PhRMA deal. Excerpt:

Yesterday, it seemed that the Huffington Post's Ryan Grim had a scoop. He reported that Huffington has obtained a memo that "confirms" that the White House and the pharmaceutical lobby secretly made a deal--the deal that I wrote about a few days ago in a post titled "What Was Billy Tauzin Thinking?" According to the memo, the White House supposedly pledged to oppose any Congressional efforts to let Medicare negotiate for discounts on drugs, or to import drugs from Canada.

The memo in question turns out to be typed--and unsigned. How does the reporter know that it is authentic? "A knowledgeable health care lobbyist" told him so. According to the lobbyist the memo "was prepared by a person directly involved in the negotiations [and it] lists exactly what the White House gave up, and what it got in return.

Wait a minute. As PhRMA senior vice president Ken Johnson points out later in the story: "Anyone could have written it. Unless it comes from our board of directors, it's not worth the paper it's written on. . . ."

And who is the "knowledgeable lobbyist" who gave the memo to Huffington? His name is not disclosed.

What we have then, is a story based on what one unnamed source says--and a typed memo that probably is untraceable.

She goes on to quote me about whether this is acceptable journalism.

In another fine example of its dedication to important health care journalism, the Milwaukee Journal-Sentinel published a piece, "Debate on MRI payments just one hurdle for reform."

Gems in this piece include:

• Information on the Access to Medical Imaging Coalition, a group backed by the major manufacturers of imaging equipment, including GE Healthcare. The paper reports: "That industry backing goes unmentioned by the innocuously named group. The Access to Medical Imaging Coalition, which includes cardiologists and radiologists, is just one of the myriad special interest groups that often oppose cuts in what Medicare pays for medical services."

• "The reality is the status quo puts a lot of money in a lot of people's pockets," said Alwyn Cassil, a spokeswoman for the Center for Studying Health System Change, a policy research organization in Washington, D.C.

  Another reality is groups such as the Access to Medical Imaging Coalition often succeed in persuading Congress to protect their interests.

Read the entire piece. It includes local angles on local industry affected and about Wisconsin legislators' activities in this area. A fine example of local journalism on a national issue.

Marketplace on NPR has begun an occasional series called "The Cure." The lead-in to the first segment said:

"Up first, the inner workings of a typical medical practice. Did you ever wonder, for instance, what all those people on the other side of the counter are actually doing? And why there are so many of them? We sent Marketplace's Tamara Keith to find out."

Keith spent the day at a doctor's practice, seeing firsthand why there were more administrative staff than health care professionals in this particular practice. They're dealing with health insurance - and different flavors of insurance from different health insurance companies. It's the American way. It's the marketplace at work that anti-health care reform forces want to preserve.

Listen to it. It's good radio journalism.

But you should also read the comments section following the text story on the Marketplace website. One guy wrote:

"I worked for Ingenix, a subsidiary of UnitedHealth group, for three years as a software developer. I worked on a crack team of Java developers who used cutting edge technology to build two huge software systems: ContractManager and iCES.

ContractManager cost $150,000 a seat. It sat in the offices of large physician practices and analyzed the doctor's rejected claims and figure out ways to bleed more money from insurance companies.

iCES sat in the office of insurance companies and analyzed claims using high technology with the intent of finding ways of paying doctors less.

Our shorthand internal way of describing what we did: "Selling guns to the Hatfields and the McCoys."

Having worked for several insurance companies, I must point out that the single payer, public option is the way to go. Right now, providers and payers are having an arms race and you and I are paying for both sides."

A physician friend of mine in Los Angeles told me her office deals with 94 different insurance plans. 94 DIFFERENT INSURANCE PLANS! And none of the people who push that paper do anything directly to benefit your health. Amazing.

Journalist Maggie Mahar blogs:

"I fear that the way the media has been reporting on reform has played a significant role in shaping the public's perception of both the president and what some like to call "ObamaCare," personalizing the issue, as if reform were merely the president's favorite hobby-horse.

Begin with coverage of health care reform. In recent weeks, Media Matters has done an excellent job of tracking how "the media continues to spread conservative misinformation on health care reform." Here are just a few examples:

 "Despite clear progress, media declare health care reform nearing "life support"

 "On health care reform, networks highlight perceived setbacks far more than progress" July 22

 "Politico ignores contradictions in calls by "moderates" for lower costs, limits on public plan" July 20

 "CBS' Smith advanced falsehood that Dems are taxing small businesses to fund health bill" July 19

 "NY Times ignores House health bill's exemption protecting small businesses"

 "Wash. Post column cites inapplicable CBO assessment to claim public plan option has 'huge cost, minor benefit'" July 07

 "CNN.com joins Republican fear-mongering about Canadian-style health care" July 07

And here I'm not even including the over-the-top distortions of the truth that have become regular fare on Fox News, and in the pages of some decidedly conservative newspapers."

There's much more on her blog.